NEW YORK STATE DEPARTMENT OF HEALTH, OFFICE OF HEALTH INSURANCE PROGRAMS

  • Guidance also available in Portable Document Format (PDF)

Guidance for the Implementation of the Integrated Benefits for Dually Eligible Enrollees (IB-Dual) Program Model Member Handbook Addendum

I. Overview

    This guidance is applicable to Medicaid Managed Care Plans (MMCP), including Mainstream Managed Care Plans (MMC) and Health and Recovery Plans (HARP) that operate the Integrated Benefits for Dually Eligible Enrollees (IB-Dual) program. The Department of Health (DOH) has developed an IB- Dual model member handbook addendum for use by MMCP who operate the IB-Dual Program. The addendum contains important information for IB-Dual enrollees regarding enrollment, disenrollment, service authorization, appeals, complaints, benefits, and services. MMCP must use this guidance to determine when to issue the IB-Dual member handbook addendum to new and current IB-Dual enrollees.

    This guidance applies only to enrollees in the MMCP's IB-Dual rate cell and is not applicable to the dually eligible enrollees that have been held in plan in accordance with federal requirements during the COVID-19 Public Health Emergency (PHE).

    This guidance is effective 10/7/24.

II. Implementation

  • MMCP are required to submit their IB-Dual member handbook addendum to DOH for approval prior to use in accordance with section 13.8 of the Medicaid Managed Care Model Contract. MMCP must submit their addendum to bigaplans@health.ny.gov no later than 11/6/24.

III. Instructions for the Issuance of the IB-Dual Model Handbook Addendum

After receiving DOH approval, MMCP shall issue the IB-Dual handbook addendum to IB-Dual enrollees as outlined in this section. The addendum shall be issued by any one of the modalities described in section 13.4(a)(i) of the Medicaid Managed Care Model Contract.

  1. Current IB-Dual Enrollees
    • During the initial implementation of the IB-Dual model handbook addendum, MMCP shall issue the IB-Dual handbook addendum to current IB-Dual enrollees within 14 days of DOH approval.
  2. New IB-Dual Enrollees
    • MMCP shall issue the IB-Dual handbook addendum to new IB-Dual enrollees within 14 days of their effective date of enrollment into the IB-Dual rate cell. Note: During the initial implementation of the IB-Dual model handbook addendum, MMCP shall issue the IB-Dual handbook addendum to new IB-Dual enrollees within 14 days of DOH approval.

10/7/2024